Efficacy and Immune-Related Adverse Events of Immune Checkpoint Inhibitors in Patients With Non-small Cell Lung Cancer and Autoimmune Diseases.

BACKGROUND

Autoimmune diseases (AIDs) are often associated with lung cancer, but their clinical characteristics remain unclear.

PURPOSE: The study aimed to elucidate the clinical features of non-small cell lung cancer (NSCLC) in patients with AIDs.

METHODS

This single-center, retrospective observational study was conducted between June 2016 and October 2024. It included patients diagnosed with primary NSCLC and comorbid AIDs who received lung cancer treatment.

RESULTS

A total of 32 patients (median age: 68 years; male/female: 14/18) were enrolled. Rheumatoid arthritis was the most common AID (10 cases, 31.3%), followed by Graves' disease, Hashimoto's thyroiditis, and ulcerative colitis (four cases each, 12.5%). Other AIDs included systemic lupus erythematosus (two cases, 6.3%) and one case (3.1%) each of Behçet's disease, dermatomyositis, myasthenia gravis, scleroderma, Schmidt's syndrome, psoriasis, and sarcoidosis. Immune checkpoint inhibitors (ICIs) were administered to 11 patients (34.3%), with a response rate and disease control rate of 63.6%. Immune-related adverse events (irAEs) occurred in 72.7% (8/11) of patients, including one grade 3 event. Of which, AID exacerbation related to ICI occurred in 45.5% (5/11) of patients. The median progression-free survival was 126 days, and the median overall survival (OS) was 1,594 days. Among patients without driver mutations who received ICI therapy, the median OS was significantly longer compared to those with driver mutations (2,274 vs. 654 days; P < 0.001). Multivariate analysis revealed that good performance status, adenocarcinoma history, and ICI administration were associated with better OS.

CONCLUSIONS

ICIs may be effective in selected NSCLC patients with AIDs; however, careful monitoring is essential due to the risk of irAE and AID exacerbation.